"Virtually Brain Dead"

When is a person no longer considered alive?

More than two years after a little girl from Massachusetts was almost a casualty of the Department of Social Services due to a misguided ethic grounded in quality of life instead of sanctity of life, the story has taken a fascinating turn. Haleigh Poultre, first thought to be more cognitively impaired than Terri Schiavo, is beginning to communicate. It is reported that she has begun to describe the abuse which subsequently almost led to her state ordered death. Contrary to doctors' assertions that she was "virtually brain dead," Haleigh is very much alive and her continuing recovery only strengthens the message of the article below which was published soon after Haleigh's close call with death.

"A day after the state's highest court ruled that the Department of Social Services could withdraw life support from a brain-damaged girl, the agency said yesterday that Haleigh Poutre might be emerging from her vegetative state." Boston Globe January 19, 2006

As I was contemplating the first anniversary of the death of Terri Schiavo on March 31 and wondering what the lasting legacy of her death might be, I was struck by a news story that is possibly more disturbing than even her saga.1

The Story of Haleigh Poutre

Haleigh Poutre is a little girl from Massachusetts who almost did not live to her 12th birthday. On September 11, 2005, after years of abuse, Haleigh was beaten nearly to death by her aunt and stepfather. She lay in a vegetative state, unable to breathe on her own, tethered to both a respirator and feeding tube. She immediately came under the control of the state, with a court appointed guardian.

Within eight days of her near fatal beating, the Department of Social Services (DSS), who had virtually ignored more than a dozen reports of physical abuse and neglect over the previous few years, applied to the courts to have her life-support removed with the agreement of Haleigh's court-appointed lawyer.2 The request to remove the respirator was approved by Juvenile Court Judge James G. Collins on October 5.

In an ironic twist, it was her stepfather, the man who had nearly killed her, who petitioned the court to leave her on life-support. One need not be a great jurist to realize that the death of Haleigh Poutre would likely to have led to a murder indictment of the stepfather. Nevertheless, his appeal to the Supreme Judicial Court pushed off implementation of the court order until January 17, when the court ruled in favor of DSS.3

The day after the decision to remove the respirator, Haleigh began breathing on her own.

The Supreme Judicial Court, in upholding the lower court order allowing removal of life support, accepted the brief filed by DSS lawyer Virginia Peel, which stated that Haleigh "is in an irreversible and permanent coma, with the least amount of brain function that a person can have and still be considered alive."4 Medical testimony seemed unanimous that Haleigh was so severely brain-damaged that not only could she could not possibly recover, but that she was barely alive. The Boston Globe reported:

Last fall, doctors described Haleigh as being in a persistent vegetative state and "virtually brain dead," district court records said. Physicians said her brain stem was severely injured, leaving her unable to think or feel and in an "irreversible coma," according to an opinion Tuesday [January 17] by the Supreme Judicial Court.5

However, the day after the higher court upheld the decision to remove the respirator, an embarrassed Department of Social Services reported that Haleigh began breathing on her own and was responding to simple commands. The following day, the Boston Globe reported that "[b]efore yesterday's disclosures, Haleigh was thought to have more serious brain damage than Schiavo, in part because she was not breathing on her own."6 As one may imagine, the unfolding story brought tremendous adverse publicity to the DSS and the explanations and excuses began flowing. Haleigh was subsequently transferred to a rehabilitation hospital for continued therapy.

The Lessons of Indifference

My intention is not to lambaste the Massachusetts Department of Social Services. Their workload is likely overwhelming and their work is surely difficult and underappreciated. Clearly, there was a string of lapses going back several years that are inexcusable, but not completely unexpected.

I am more concerned with the lesson we learn from the Haleigh Poutre saga and what it tells us about our approach to life and death. I would sleep much better if I believed that the chain of events that almost led to Haleigh Poutre's death were innocent mistakes. It would be easier to deal with a lab error or a lapse in judgment. But, I think the underlying failure in this case came about because the lives of the mentally handicapped are simply not valued in our utilitarian society.

As I argued one year ago, my primary issue with the Terri Schiavo episode was that instead of rational arguments for ending her life, there was an underlying sense that one must be crazy to care about someone who could not think. I appreciate the complexity of end of life issues and recognize that there is legitimate debate among good-intentioned people regarding how to deal with those questions.

It is a major leap from terminal illness to valueless life.

But it is a major leap to go from terminal illness to valueless life. To debate and discuss how aggressively to treat a patient with an incurable disease is healthy. To discuss ending the lives of people because we see no value in their continued existence is reprehensible. When the lawyer for Haleigh's stepfather requested that the court obtain the medical opinion of a neutral physician, the judge said, "When you have consistent medical opinions, why do you have to find a doctor who might challenge that?"7

You have to look for a doctor who might challenge that because a little girl's life is on the line. When one values something, one is pained by even the possibility of its loss. America has a long history of recognizing that a life need not be pleasant to be deemed valuable. For example, on July 7, 1865, on the day the Lincoln assassination conspirators were to be hanged, sentries were posted between the White House and the prison where the executions were to take place, ready to relay the news to the executioners, in the unlikely event that President Johnson would grant last minute pardons.8 Such an action for such morally repugnant assassins was not performed because the conspirators were liked, but because of recognition that extinguishing life is a very serious matter and all actions must be taken to avoid unnecessary killing.9 It is not the individual that necessarily deserves respect; it is human life itself that deserves respect.

Mere potential threats to our civil liberties are taken very seriously. This is because of the very natural fear our rights will be eroded slowly, on a case by case basis and that we will not recognize what we have lost until it is too late.

There is an inherent feeling of anger when a criminal who confesses to a heinous crime cannot be prosecuted because of a legal "technicality." Who would not be angered that the admission of guilt is not admissible in court because the accused did not have legal counsel when he made his confession? But on further consideration, we tolerate such situations since we fear that not scrupulously defending the rights of defendants will lead us down a path toward tyranny. Our legal system is predicated upon the idea that it is better to release 10 guilty people than incarcerate one innocent one.

Respecting human life is analogous. It is very easy to look at an individual person in a persistent vegetative state and feel that their life has no value and continuing their life is "wrong." But our respect for life, like our respect for our civil rights, demands that we judge based on the bigger picture. Without a very clear line in the sand, it is impossible to recognize, except in retrospect, when we have gone too far in devaluing human life and crossed the threshold into the realm of state-sponsored murder.

Genocide does not start with overt murder; it starts with devaluing the lives of unwanted members of society.

Genocide does not start with overt murder; it starts with devaluing the lives of some unwanted or unpopular members of society and follows a downward spiral to depravity. Often, as in the case of Nazi Germany, the first group to be disposed of is the disabled, particularly the mentally handicapped. The arguments for euthanasia are always euphemistic and always couched in language suggesting that we are killing the individual for their own good. We never propose murder, we propose "mercy-killing" and allowing the patient to "rest." We wish to end the suffering of people who might not be experiencing any pain whatsoever.10

We are already near the bottom of the slippery slope. Thirty years ago the New Jersey Supreme Court made the revolutionary decision in the case of Karen Ann Quinlan that respirators may be removed from brain damaged patients, but the feeding tube was left in place, for how could one consider starving someone to death?11 In 1990, the Supreme Court of the United States established the principle that a feeding tube may be removed from a PVS patient if there is "clear and convincing evidence"12 that the patient desired such an outcome, for how could one starve someone to death without very compelling evidence of their wishes? In 2005, in a very contentious public case, the courts allowed removal of a feeding tube from Terri Schiavo despite the lack of written advanced directives. In that case, the parties seeking to disconnect the patient, principally her husband, had several serious conflicts of interest13 and the legal decision was made based on the recollections of her husband (and others) of off-handed comments, only seemingly recalled many years after the patient entered her PVS state.

So while the thought of attacks on our rights brings out the civil libertarians, the same concern is not demonstrated when innocent human lives are being threatened. As we will see, the case of Haleigh Poutre demonstrates that we had even farther to fall even after Terri Schiavo, who was at least an adult who theoretically could have had an opinion about her care before her collapse.

The Rest of the Haleigh Poutre Story

Reading the chronicle of events as they unfolded tells a very troubling tale. Soon after it was made public that Haleigh began showing signs of recovery, it was also reported that the improvements had begun a week before the Supreme Judicial Court had issued its ruling to allow removal of the respirator, but that despite the Department of Social Services knowing of the improvements, they did not inform the court.

In fact, the Boston Globe reported on February 7, 2006 that "Susan Molina, executive director of the Yellow Ribbon Kids Club, said yesterday that she filed a complaint against DSS lawyer Virginia Peel, saying Peel had not told the Supreme Judicial Court that Haleigh, 11, was starting to breathe on her own and was showing increased responsiveness."14

When the state Department of Social Services Commissioner Harry Spence was confronted with this information, he claimed that the doctors had misled him and that "his agency did not tell the state's highest court that Haleigh Poutre might be getting better because doctors convinced him that she would never recover from a vegetative state."15

Spence said Haleigh was showing signs of responsiveness about a week before the Supreme Judicial Court granted permission to remove her life support. But he said Haleigh's doctors reported that her movements were not a sign she would recover. "When there was evidence there were signs of improvement, we insisted the doctors reexamine Haleigh and come back to us," Spence said yesterday in a telephone interview. "They absolutely affirmed that the chances of her recovery were absolutely zero. There was nothing for us to report to the SJC."

While it is difficult to know where the truth lies, one might suppose that in their rush to extubate Haleigh and remove her feeding tube, there may not have been an attempt on the part of DSS to obtain the best medical information.

In the most charitable scenario, the courts relied in good faith on DSS to provide accurate information regarding the prognosis of Haleigh Poutre. In turn, the DSS relied upon the doctors to provide accurate medical information. Not only did the physicians misinterpret Haleigh's early signs of improvement as irrelevant, but they committed a far worse breach of ethics.

The doctors, the only people with the expertise to judge the medical situation, did not advocate for their patient. It is well known in medicine that the brains of children are very resilient, far more so than those of adults. The words of the Boston Globe are again enlightening.

Several neurologists say that many brain-injured patients recover some consciousness, but often not for several months or more, causing families frequently to delay for months before making the heart-rending decision of whether to continue life support and come to grips with their own definition of what constitutes a life worth saving.

"Three weeks is early with what we know can happen with recovery," said Dr. Nancy Childs, executive medical director of Texas NeuroRehab Center in Austin, Texas, who has been working with brain-injured patients for more than 20 years.

Childs said statistics show that 52 percent of brain-injured adult patients recover consciousness a month after their trauma and that 16 percent recover after three months. She also said that, in general, brain-injured children, with their growing and elastic brains, "have a better outcome" than brain-injured adults.

There are many factors that impact the prognosis of patients with severe brain injury, including length of oxygen starvation, scan findings, and rapidity of onset of symptoms.16 But even for patients with severe brain injury leading to a vegetative state, standard medical care would usually require at least several months, not several days, before the doctors could conclusively determine that there would be no further improvement. How could the doctors make the assessment within eight days that a comatose child who suffered trauma would remain permanently vegetative when the definition of persistent vegetative state is at least one month17 of coma and children tend to have a better prognosis than adults? Where was the motivation to err on the side of recovery?

I am forced to the conclusion that her life just did not matter enough to take the time necessary to do a proper evaluation and her severe brain damage did not merit erring on the side of interpreting her spontaneous breathing and increased responsiveness as true improvement.

To those people who would argue that autonomy and self-determination are important values, I would agree. But where is the autonomy and self-determination in quickly withdrawing life support from a patient before we could possibly know if they will recover, particularly a child with no family or true advocate, who has no advanced directive, and with no reason to believe the child would want support withdrawn (nor that they could even evaluate such a question)?

Autonomy and self-determination are important values, but preservation of life is also an important value. Ethics is always the clash of two ideals that cannot both be accommodated. Most people would accept that truth-telling and saving lives are both laudable ideals. However, if faced with the dilemma of whether to inform a potential murderer where his intended innocent victim may be located, the two ideals come into conflict and one must be chosen over the other. For a moral person, saving lives must come before truth-telling or even autonomy in some cases. It is a perversion of decency to adopt an ethical system that places autonomy above all else.

So we go from Karen Ann Quinlan in 1976 to Nancy Cruzan in 1990 to Terri Schiavo in 2005 to Haleigh Poutre in 2006. Is this really the bottom? Probably not.

As we slide deeper into the abyss of abandoning our respect for life, our ethical decisions are increasingly being outsourced to groups such as the courts, governmental departments, and most sadly of all, doctors, who all too often do not view life as intrinsically valuable. Life is no longer the desired default.

Physicians, like all others, can make mistakes. Overworked social workers can err. I work with many physicians, all of whom have a deep dedication to helping others. I am sure that everyone involved in the Quinlan, Cruzan, and Schiavo cases also thought that they were offering the best care for their patients. Michael Schiavo may really have loved his wife as he argues in his new book and he may honestly think that he kept his promise to her.18 But good intentions are not sufficient.19

We have created a culture in which life itself does not matter.

The real issue is that we have created a culture in which life itself does not matter. Many people absorb their morals from the milieu in which they are immersed. Within such a culture of disposable human life, one may feel comfortable and morally justified in killing those people whose lives are not worth living. I often wonder what people perpetrating the killing in Germany, Cambodia, and Rwanda were thinking while the killing was happening. I do not believe that people in societies involved in genocide think that they are doing evil. The culture simply shifts to allow for people to "feel okay" with acts that might otherwise be considered evil. That is, there is no covert conspiracy in America involving government, lawyers, and doctors to kill innocent people. There is merely a dulling of our moral sensibilities that leads to the bad outcome. We look back only afterwards and then it becomes easy to trace the path that led from normalcy to immorality.

While the story of this little girl is horrifying, it is merely a symptom of a larger problem. The Haleigh Poutre case indicates the direction in which we are moving. Maybe it will serve as a wakeup call to take notice of where we are heading and to examine to whom we are abdicating our decision-making apparatus, before we have to look back and wonder what happened to our society.

This case should remind us that while we may choose to outsource some of our decision-making to experts, such as the safety of airplanes or the health-quality of our food, we must be very careful not to abdicate our moral decision-making capacity to others, merely because of their technical expertise in a given field. Evaluating the safety of an airplane may take an engineering degree and evaluating a patient's medical condition may require a medical degree, but judging the value of a life only requires an intact moral compass. Unfortunately, moral compass-building is not a required course in most universities and graduate schools.

So, we are still left with two questions. Whose moral compass will be used to chart the future path of our heterogeneous society and how does one develop a healthy moral outlook for himself? As a nation, we will never all agree on one source for morals, and various ethical perspectives vie for acceptance in our society. While society is often swayed by the loudest and most influential voices, sometimes, just sometimes, it is the voice of moral authority that carries the day, even against tremendous opposition, such as in the case of a leader such as Martin Luther King,

As Jews, our greatest contribution to the debate is to become voices of moral authority. Throughout our long history, our tradition of strong support for the value of each individual life has been a light to the nations and source of societal morals even in the most turbulent of times. It is through our study of the Torah that we acquire a solid basis for our moral growth and develop our own moral compasses. We must continue to use the Torah as a stable source of morality, or, as the whims of society change our cultural values, our personal ethics will shift with them.

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About the Author

Dr. Daniel Eisenberg is with the Department of Radiology at the Albert Einstein Medical Center in Philadelphia, PA and an Assistant Professor of Diagnostic Imaging at Thomas Jefferson University School of Medicine. He has taught a Jewish medical ethics class for the past 15 years. Dr. Eisenberg writes extensively on topics of Judaism and medicine and lectures internationally on topics in Jewish medical ethics to groups of all backgrounds. Obtain more information on scheduling a lecture or learning more about Jewish medical ethics by visiting Dr. Eisenberg at www.daneisenberg.com

Visitor Comments: 39

(39)
chava,
May 27, 2014 4:17 PM

State of Massachusetts

Isn't Massachusetts the state that took custody of Justina Pelletier away from her parents? She was being treated by a doctor from Tufts for a rare disease that he believed she had. She was doing fine. She contracted a respiratory problem, so the doctor sent her to a different doctor who had treated her previously. That doctor never got to see her because a resident in the emergency room decided that she didn't have the original condition, and that the parents were abusing her medically by having her treated for it. The parents advocated for her, but this resulted in custody being taken away. She's no longer being treated for the first condition, and is now in a wheelchair and unable to attend school or church. Check out the details on the internet. I think Massachusetts has some big problems.

(38)
Eric Rachut, M.D.,
April 6, 2013 11:56 AM

Evil in White Coats

Excellent, excellent. I would only add that it was PHYSICIANS who promoted euthanasia under the National Socialists (they responded with alacrity) and who continued it for months after the fall of that regime. Evil may at times have kindly face!

(37)
Leon Zacharowicz MD,
December 5, 2011 12:25 AM

Brave New World

As a neurologist brought in by Agudath Israel of America to testify in several end-of-life cases, including the landmark Golubchuk case in Wiinnipeg, I can say that there has been a radical shift in end-of-life care toward rationales such as quality of life which are aimed at justifying the withdrawal of care from patients, resulting in their premature death. Welcome to the Brave New World of "futile care" theory, cost / benefit analysis and perhaps even death panels.
Those who face doctors and hospitals bent on shortening the life of their loved one should contact Agudath israel of America's legal counsel, Rabbi Mordechai Biser, at their main office in Manhattan.

(36)
Anonymous,
June 11, 2008 12:54 PM

Morality or not

As a person, as a Jew and believer...
I saw family suffer, shrink to less than humans because of alzheimer, cancer,....and, I am an advocate to a person's right to decide when suffering
is enough and when doctors are incapable of helping because they don't know everything and can't help or do much at a certain stage.

I have been unlucky to have had a nerve touched and suffer from a neuralgia. I take morphine and many of those anti-epileptic medications cause terrible side effects....And, after all
and many drugs that I received, I suffer also from a tardive dyskinesia.

At times, when, I don't feel like a person, a wife a mom because of those electrical, excrucibating pains, fainting for lacking the strenght to support it....believe me, I wish, I would sleep forever and ever. The bad days taking over a few good days, isolating you from people....activities,

Crying and hiding....from my loved ones and feeling like a schmate, incapable of doing anything for them has shown me that people nor doctors who are not in the shoes of people who go through hell day in and day out, have not much to say. And, a pat on the shoulder nor words are encouraging:believe me.

(35)
Beverly Kurtin,
June 10, 2008 11:29 PM

"Kiss her goodbye..."

That is what one doctor told my family after I'd suffered a massive stroke. My family instantly fired the quack and hired a doctor who valued life, any life. That was 18 years ago and although I am still recovering, I returned to work exactly six months to the day of my stroke.

'Nuff said?

(34)
Dicky van Gelderen,
June 9, 2008 11:08 AM

collective influence on individual moral conscience

How guilty I feel, for having been so influenced by a general trend eroding our ethical sensibilities, how easy it is to blame THE TREND and societal expextations. How easy it is to be the nazi-german bystander or perpetrator. Man being inexhaustably socially adjustable tends to go against his basic instincts of decency and morality. But what about the many, many people left to die bereft of necessary medication for lack of medical insurance coverage. In the UK anyone in need of dialysis above a certain age, not being able to afford it will die!!
Your article supports the need for a set, and immutable code of ethics based on the support of life as the most basic of rights.

(33)
Helen Porath,
June 9, 2008 6:30 AM

My father was "put to sleep" in front of my eyes.

I live in Israel, and my only sibling, my sister,lives in Holland. 15 years ago, we went to England to be with our dying mother, then 10 months later, we looked after our father, in the same little hospital outside London, during his last week of life. On his last night, I was with him alone, while blood was trickling slowly out of the corner of his mouth. None of the night staff - who were not the regular nurses, but people from an agency - gave me a box of latex gloves, and told me to clean him up myself.
Morning came, and the trickle of blood had turned into a torrent, which the nurses tried in vain to staunch. The doctors hadn''t come back from their weekend, so there were only nurses. My father was screaming and choking, when a senior nurse was summoned from another department. She took one look and then administered a morphium injection which killed my father.
It was indescribable to see a live person suddenly become a lifeless pile of pyjamas, rendered thus by the giving of an injection.There was nothing "dignified" about it. Rather, it was like taking a dog to the vet to have him put down. There was probably
nothing else that the nurse could have done for my father at this stage (she couldn''t have let him choke to death) so why I am writing is this:
This nurse, having put an end to a life, for whatever reason, finishes her shift at the hospital, and must return to her family and function as their mother and wife. She must learn to put her working day aside, and not think too much about it. "Well," you may say,"All doctors and medical staff see illness, pain and death as an inescapable part of their work, and they, too, must , go home to their families and function as regular people. If doctors and nurses collapsed into a weeping fit every time a patient died, they probably wouldn''t last very long as caregivers."
Being able to put their work to the side and function as a regular person when off-duty is a perfectly reasonable phenomenon, when - and this is my point - medical staff deal with the inevitable distress encountered in dealing with sick and dying people.
Administering lethal injections, turning off life-supports, do not, in my opinion, fall into this category. And as Jews, especially, we should be wary of people who are capable of performing these tasks, who do not find them "problematic", who can "get used to them" and feel unaffected by them when they come off-duty. For WHATEVER REASON, a life has been shortened by a person whom we trust to preserve life.
Being British-born, I am a great believer in hypocrisy!
I am sure that people caring for terminally ill cancer patients for whom morphium can do no more, and are screaming in agony, have "helped" the patient in his final moment.
But I feel that legalizing "mercy killing" would open doors to abuse which we would never be able to control.

(32)
Benjamin Narbuth,
June 8, 2008 9:06 PM

End of life issues

So many comments about ending the life of a person before the time determined by God. So many comments about respect for life. Why no comments about the common practice of abortion, which deliberately takes the life of a living person, denying this person the God given right to life? Is not the life in the womb as valuable as the life of Haleigh in her hospital bed?

(31)
Sherry,
June 8, 2008 10:45 AM

I agree w/Joy''s analysis 100%.

Terry Shivo wasn''t "virtually brain dead" she WAS brain dead.

(30)
FAL,
June 8, 2008 10:30 AM

RE: allow life to be lived and died in peace

Joy, i agree with you completely and there is absolutely nothing else that i can add that would even come close to your ''on the mark'' comments.

(29)
Michael Oberndorf,
June 8, 2008 9:50 AM

Abdication

Turning over the right to make life and death decisions to government agencies and courts is a formula for eventual disaster. I the case of Miss Poutre, it would appear that God intervened, because the State appears to have been hell-bent on getting rid of an unwanted piece of what it apparently percieved as human trash. This is not surprising, given the collectivist mindset of far too many judges and bureaucrats. The notion of serving the "greater good" is an excuse to trample the rights - including that of right to life - of the lesser members of society, i.e., the poor, the elderly, the handicapped, in other words, those who cannot defend themselves against the power of the State. As Dr. Eisenberg points out so well, we have become an amoral society, and if we do not find our way back to principled living, we will not live in freedom for too much longer.

(28)
Robby Berman,
June 8, 2008 8:10 AM

Virtually Pregnant!

I don''t think anyone would title an article "Virtually (or Almost) Pregnant." The option is binary. You are either are or you aren''t. There is great confusion among laypeople between coman and brain death. Some believe that you can awake from brain death, ass you can seen from Meir Lazar''s feedback (#24), where he implies his child awoke from brain death - a medical impossibility.To better understand this issue go to the Halachic organ Donor Society website www.hods.org

(27)
Katie,
June 8, 2008 8:08 AM

Do not act in haste

I am a nurse. I had a severely injured and supposedly "brain dead" patient who had been made a No Code, meaning if he went into cardiac arrest from his injuries, no attempt would be made to save his life. As I cared for him, I felt the diagnosis was a mistake and had a nursing consult with a neuro nurse specialist, who validated my observations. I continued stimulating his with television, music and even bits of chocolate tucked into his cheek. His condition improved enough to leave ICU. One day his mother ran in to see me with a note her son had written...1 month after his accident, he was awake! He could not speak as yet, but his handwriting was legible and made perfect sense.
The experts said this would not happen.
We must fight on that life is not devalued.

(26)
Aviva,
June 8, 2008 7:55 AM

Iam a Registered nurse and work in what is called a ''step-down'' ICU or INtermediate care unit. Although in this case maybe removing life support would have been premature and a tragedy...Time and time again Ive seen people lose all dignity and resemblance to any kind of human life because poeple refuse to let go! I have seen so many peoples lives become nothing more than lying in a bed unable to speak on a respirator, unable to eat without a feeding tube, stooling themselves all day longt with bedsores all over-flesh rotting off the bones because they cannot move even an inch. And therir families chose to keep them alive this way even though this is the best their life will ever be! With no hope of improvement, independence or meaningful communication or activity- This is not life- And that is my point. There is a major difference between keeping people alive for a a reason and carrying on medical futility- and causing extremem suffering. Ask the nurse the expression on a patients face that cannot speak when we clean a bedsore! or draw blood on these poor people that cannot even telll us- hey stop!! I want to die!!- think about that...One day it could be you in that bed - unablt to say no more treatments, no more needles, no more tubes.....

(25)
ruth housman,
June 8, 2008 6:08 AM

the voice of moral authority

It seems in life we are constantly being forced to examine moral issues for which there are no clear answers, meaning they are not so evidently black or white but exist in the gray areas. We must use our gray matter coupled with angst and compassion to make decisions that are inordinately difficult. Certainly we make "mistakes" but when they are made with the proviso we do our best in this manner I am saying this is the moral imperative.

(24)
Joy,
June 8, 2008 5:47 AM

Allow life to be lived and died in peace

It is a deeply personal decision whether or not to sustain an individual on life support and is no more the business of the public media, courts, and legislators than is your personal prayer choice and belief. I live near the community in which Terry Schaivo lived and watched the media and political circus of throngs who lined up to use her suffering to support their personal agendas. It was a travesty of humanity. As a Jew, I was apalled and aghast that for years this woman could not die peacefully and enter the light of her Creator because every other politican or media pundit had his or her hand on her mind and body for personal power and glory. For each soul that doctors encourage the family to allow to die, there is another that doctors encourage to remain on life support when the family feels the need to let go. What is appropriate is what is in the hearts of family members who must choose a humane path in these heart-wrenching cases. I watched the self-proclaimed pious ones block the streets around Schaivo and pronounce that they were praying for well-being â€” but it was a choice between her, her family, and her creator when she must leave this world and enter the light. What a selfish act for people who have no connection to the family and no need to make themselves part of this decision other than to display their own self-righteousness. And how ironic that you use Shiavo''s case in your discussion, considering that her brain scan after death proved there was nothing left of her brain and that all of the claims made by politicians, pundits, and pious ones that she was thinking and communicating were impossible and had been for years. After the long media circus, when she was finally allowed to die and the defeated politicians shuffled off to their respective worlds, her loved ones were left to mend the pain and loss. Now let her rest in peace and STOP using her to justify your own self-righteousness and political ends. The cases you exemplify and the ones in comments that follow are deeply personal instances in which families made difficult choices for the well being of a loved one. They are a testament to the individual power of belief and prayer to sustain us through even the greatest trials. In some cases a miraculous recovery occurs. In as many other cases, a life cannot be sustained. You imply that every human being ought to remain on life support ad infinitum because some have returned seemingly from the dead. There is no "norm" here. We live our lives in a myriad of possibilities, and so we die by a myriad of means. Keeping a human body alive through artificial means when it is time for that individual to die is a pervision of human life. It is not your right to decide how people live and die ... only your privilege to support the family''s decision, knowing that they have done so through the deepest pain and the sincerest convictions of their hearts.

(23)
rita,
January 10, 2007 5:17 PM

My sister was bleeding in her brain while under going a stem cell transplant. We were told she was a vegetable and could not think or understand by all the doctors attending her. She had no immune system and her platelets were too low to operate on her. Within hours of this happening the doctors gave up on her. We were asked if we wanted her to be removed from the resperator. They also refused to give her transfusions to strenghten her immune system saying what was the point, she was a vegetable and would never have quality of life or be able to walk again. We contacted our Rabbi, he asked the doctors one question would she be able to make a braha. They said it was too soon to tell. The Rabbi said to us demand they treat her agressively and give her the transfusions. After about five days of demanding the transfusions the hopsital finally gave in. The end result was she was in a coma for two weeks and then came out of it, she was paralyzed on one half of her body for four weeks and at the end of the four weeks she had some movement on her left side. Today the vegetable can walk, she has aphasia(can not find words to fully have a conversation) but she still leads a life of quality, her four children, and husband are thankful they have a mother and a wife and yes she can say a braha. It scares me think if we listened to the doctors and not consulted with a Rabbi.

(22)
Anonymous,
June 21, 2006 12:00 AM

I agree

As a Christian and member of the I.F.C.J I concur and fully support Dr Eisenbergs comments.
We have allowed our "enlightened" status and our lack of moral fibre to over ride what we know to be immoral and evil.

(21)
Margarita,
May 21, 2006 12:00 AM

wonderful story

wonderful story. i think that there is not much regard for human life, and people should not be starved to death (or dehidrated). I think that what happened with Terry is horrible, and everyone who disagree with me have to ask themselves simple question: does anyone deserve to die that way. Even killing criminals is done not that slow and painful (and by the way before the autopsy how much did we know about the brain, and what to do with the nurses who say she was breasing partly on her own and had periods?) Thank you for the great points in the story, and i will be looking forward to hear more from you

(20)
Rabbi Avrohom Marmorstein,
April 18, 2006 12:00 AM

Importance of evidence submitted by medical professionals

Dr. Eisenberg's article is noteworthy because it underscores that he, as a trained and practising physician, is aware how easily a patient can be written off as beyond hope and consigned to the "brain dead" despite the possibility, however remote, of recovery. Often, in my experience as a hospital chaplain, physicians are acutely aware how small the possibility of recovery is, and this pushes them against thinking about the fact that sometimes the patient is not yet brain dea, or even in an irreversible vegetative state.

(19)
Anonymous,
April 5, 2006 12:00 AM

We should never take what does not belong to us.

If G-d doesnt want a person to live, no amount of prayer or of human intervention, of tubing or feeding would keep the person alive. The fact that Terri Schiavo's heart was beating meant she was alive. Even if it was her decision not to want to live in a vegetative state, it was neither hers nor anybody elses to take away. It is G-d's.

(18)
Anonymous,
April 5, 2006 12:00 AM

please tell me the end of the story

I understand the author wanted to use the story as an example and the details of the story are second to the lesson, but from someone living abroad and totally unfamiliar to the story, can you please let me know what happened to the little girl.
The article implies that there was not immediate death and there was improvement. How far did the improvement go?

(17)
Anonymous,
April 5, 2006 12:00 AM

This case is not simply about our crass indifference for human life. It seems more a case about the deplorable state of affairs the network of social services for children and families is in.
The so called "religious" right and others who claim conservative, traditional and moral values support wholeheartedly the cutting of funding to social services in exchange for larger tax breaks.
As a result you have too few social workers juggling too many cases. I know many social workers who struggle on to do their best working 60 to 70 hour weeks while making maybe 25k a year. They have to protect children from abuse, neglect and goodness knows what else. Unfortunatley many have to make the choice about which children are suffering more because they simply are not able to tend to all of them.
TO further complicate this there aren't enough good foster homes, some are worse than the homes the kids came from, and fewer even permanent adoptive families willing to take in children who are troubled and imperfect and love them like they are their own.
There are also a severe lack of good orphanages and waiting lists a mile long for counseling and medical services.
Haleigh should have never even been beaten to that point in the first place. THe money, personell and general infrastructure should have been there to protect her and the untold numbers of other children who are today being abused and neglected.
In the end she finally has advocates. She had to be beaten within an inch of her life, be hospitalized and then be threatened with termination for anyone to really care.
What will happen to her once she leaves the hospital? Will someone who fought for Terri Schiavo's right to remain on a feeding tube see it in their hearts to save this little girl? Will they see her through a long and difficult recovery? Or will she end up again neglected and shunted off to the side languishing wiht substandard care and no one to love her?
I don't have much hope to tell you the truth that she'll be better off alive, I've personally seen far too many of these kids during my volunteer work who are living a nightmare and getting anyone wiht power to care is an almost impossible feat.
If only a tiny fraction of the effort spent on Terri Schiavo and the ANti-Abortion protests was spent on saving real live children like Haleigh then maybe some real different could be made in the world. But I guess its easier to stand around all day with a sign claiming to be pro-life than actually doing something to save a life.

(16)
Paula Siddoway,
April 3, 2006 12:00 AM

THANK YOU

Thank you for publishing this article, I only wish people would LISTEN and CARE!

(15)
Dr Jose Nigrin,
April 3, 2006 12:00 AM

Borderline

There is a borderline point where you don^t know, if a patient in a vegetative state, is suffering more, without getting nowhere, than having an appropiate living.

(14)
Leah Bourne,
April 3, 2006 12:00 AM

conspicuously absent

I am surprised that no one has made the rather obvious statement that what was really motivating Massachusetts was simply a wish not to have to pay for her medical care with medicaid or whatever they use there. To them, the money was more important than her life. Once she was in their custody they had a legal obligation to act in loco parentis. Instead, they treated her like an accounting line item. This is what America is now.

(13)
Rachel,
April 3, 2006 12:00 AM

Do You Have a Human Heart & Soul

Regarding Beverly Kurtin's comment that Terri Schiavo 'supposedly' starved to death: Terry Schiavo starved and was dehydrated to death. She did not 'supposedly' starve. Until her feeding tube was removed, Terri had been breathing on her own. Her nurses testified that she menstruated. Her brain was severely damaged, but it was not dead. I never knew that blindness qualified somebody to be put to death, especially in the opinion of a number of people who believe in saving the lives of murderers.

These people who call Terri Schiavo or Haleigh Poutre 'root vegetables' disgust and revolt me. They are mean and vicious little persons who have lost their souls and have no heart. Dr. Eisenberg is right that we are heading down a slippery slope, and it is important for all Jews to speak up in favor of life. CHOOSE LIFE THAT YOU WILL LIVE, YOU AND YOUR CHILDREN!

(12)
Marcia Wilkow,
April 3, 2006 12:00 AM

Let's Talk Apples and Apples

The use of Terri Schiavo's name as part of the title for this article (which in and of itself is enlightening and frightening at the same time) is to capture the audience through the capitalization of Ms. Schiavo's name.

With the exception of the fact that both suffered severe brain trauma, there is no dorect relationship to the circumstances surrounding the leading up to the removal of life support for Ms. Schiavo and this unfortunate little girl.

One was in a vegetative state for many years and given appropriate care, hoping for rejuvenation; one for only 3 weeks, with apparently no direct care which could lead to waking up.

I for one would have more readily read the article if it's title pointed to the poor care given not only to this child, but G-d knows how many more, who have found themselves in this or other medical situations where the outcome is questionable.

Further, what should have been the focal point was the need for reform in those cases where doctors, attorneys, guardians, etc., are quick to decision.

Thank you for allowing me to have my say.

(11)
Robert R. Newport M.D.,
April 2, 2006 12:00 AM

Changing the definition of death

We are undergoing a rapid technological development which within the the lifespans of those who are being born now, will expand the capability of medicine to eliminate the inevitability of death. Molecular Biology coupled with Nanotechnology will within the next 30 to fifty years make aging and the diseases associated with it a thing of the past. Now, today, we have the capacity using cyrogenic suspension, to prevent "biological death", namely the ischemic cascade, after "legal" death, namely cardiac arrest, has been declared. We are assured by the leading nanotechnologists, many of whom have "put their money where their mouths are" by contracting for the procedure to be performed once they are declared, that it will be possible to reverse the injuries which currently are taking our lives, in the not too distant future. Would it not be consistent with the morality of life, to at least offer cryogenic suspension now, to those who will legally die before the new technologies come on line? Thank you, Robert R. Newport M.D.
The references for my allegations in the above paragraph may be found at www.alcor.org/library

(10)
Anonymous,
April 2, 2006 12:00 AM

Tearfull, Hurtfull,and Maddning,

WHERE IS Gd WHEN WE NEED HIN,WHERE DOSE WISDOM GO WHEN WE LOOSE IT.

(9)
Beth Lopez,
April 2, 2006 12:00 AM

We have hearts and minds to change still

It took me the week to work up the stomach to read this article. The Terri Schiavo issue took a lot out of me while it was going on. I was so suprised and horrified how many people were angry that we were devoting so much time to what they felt was a non-issue.
Dr. Eisenberg's article was the best thing I have read this year. I have e-mailed it to all my friends and family saying as much too.
From what I am able to tell in speaking to people and watching the polls most people supported killing Terri Schiavo which means we have a long way to go in changing the hearts and minds in America and elsewhere throughout the world. A conversation well worth having.
Thank you Dr. Eisenberg for the work and follow-up article you really demonstrated that we are on a dangerous path in devaluing human life. Your article is a strong moral and ethical statement and is in lock step with "ethical monotheism," which is the message and the reason we as Jews are "the chosen people."

(8)
Ed Dockery,
April 2, 2006 12:00 AM

I cried.

My emotions are to high to allow for a rational comment.

(7)
Beverly Kurtin, Ph.D.,
April 2, 2006 12:00 AM

Died 15 years earlier

Terri Shaivo died 15 years before she was supposedly starved to death. The autopsy showed that she was blind, had virtually no brain left, and felt no thirst or hunger as those parts of the brain that could have felt those simply were not there.

The circus that went on about "pulling the plug" angered me to the point that I simply pulled the plug on my TV until I heard that it was over.

Can anyone tell me that the amount of time, energy, and effort that went into keeping a corpse's heart beating for 15 years following her death could not have been put to better use, like researching what caused her brain to die in the first place.

I salute the courage, love, and grace under fire that her husband had to put up with.

Fanaticism should NEVER trump science. Politics should NEVER come into the picture at all.

Once again, the autopsy showed zilch inside her skull. The woman had died a decade and a half prior to the shameful circus that surrounded last year's events. Her parents ought to be ashamed of themselves for their repeated lies about "she said she wants to live" when there was nothing inside her skull that could have remotely allowed her to speak. They owe their former son-in-law an apology that I know will never come.

(6)
Yitzi Tuvel,
April 2, 2006 12:00 AM

Two arguments, not one

I like many of the arguments and the research seems excellent, but I can not understand the shift from "Society can't be trusted to make moral decisions, we all need to make our own moral choices" to "Our moral compasses are inefficient, we need the Torah here to teach us how they work."

It seems to me that far more space is necessary to concoct a robust defense for the second argument.

(5)
Sarah Erman,
April 2, 2006 12:00 AM

We need a more appropriate comparison

Comparing Terry Schiavo to Haleigh is like comparing onions to potatoes. They both are root vegetables, but there the similarity ends. Terry was in her vegetative state for many years, and as was proved by her autopsy, was even more brain damaged--blind and totally unaware--than was thought. If you are going to use the Terry Schiavo case as an avenue to disallowing the ending of life support, then you need to compare with someone whose life support lasted nearly as along. Also, Terry was an adult, who, according to her husband, did not want to be kept alive under such circumstances.

(4)
Tracey S.,
April 2, 2006 12:00 AM

The other side

Of course, we will always hear stories of miraculous recoveries from comas, etc., but it seems that no one thinks about a) the person in the bed who truly, by all diagnosis, no longer has the capacity to do all that is necessary to be considered a viable life and b) the family who has to watch this shell of a person just lie there. What dignity is there in that?

True, we should do whatever is possible, but there is a time to let go. Unfortunately, modern medicine has made it harder to do so, always promising the miracle, even after it's been shown that the person in the bed is irreparably damaged. In the case of Terri Schiavo, I believe her husband did all he could for seven years (including getting a nursing degree so he could care for Terri) and was the most sane by wanting the empty shell his wife had become to be allowed to go with dignity.

(3)
Jeremy Yates,
April 1, 2006 12:00 AM

Very interesting!!!

As a mental health advocate this is powerful stuff because often times psychiatrists ruin what could be normal productive lives in the name of medicine and mental health.

(2)
Anonymous,
March 31, 2006 12:00 AM

fabulous article!

so compelling! A must read!

(1)
Meir Lazar,
March 31, 2006 12:00 AM

Similar situation

I have a child who is now almost four months old. He went into a coma on his second day of life and was put on a ventilator. His condition degenerated until they pronounced him brain-dead. The doctors tried to push us to terminate him; told us that he will never come out of it, and even if he did, he would be in a vegetative state due to his severe brain damage. We told the doctors we will do exactly as our Rebbeim say. They told me not to terminate on the advise of the stricter halachah. A week later, he emerged from his coma. A few weeks later he starts moving again and responding to stimuli. He is now growing wonderfully and ready to come home from the hospital (although still on a ventilator) Listening to the Rabbis and not listening to the pessimistic, atheistical doctors (who wanted his organs) saved our child's life. Teshuvah, Tefillah, and Tzedakah overturns evil decrees. Trust in G-d, he will literally make miracles for you.

I just got married and have an important question: Can we eat rice on Passover? My wife grew up eating it, and I did not. Is this just a matter of family tradition?

The Aish Rabbi Replies:

The Torah instructs a Jew not to eat (or even possess) chametz all seven days of Passover (Exodus 13:3). "Chametz" is defined as any of the five grains (wheat, spelt, barley, oats, and rye) that came into contact with water for more than 18 minutes. Chametz is a serious Torah prohibition, and for that reason we take extra protective measures on Passover to prevent any mistakes.

Hence the category of food called "kitniyot" (sometimes referred to generically as "legumes"). This includes rice, corn, soy beans, string beans, peas, lentils, peanuts, mustard, sesame seeds and poppy seeds. Even though kitniyot cannot technically become chametz, Ashkenazi Jews do not eat them on Passover. Why?

Products of kitniyot often appear like chametz products. For example, it can be hard to distinguish between rice flour (kitniyot) and wheat flour (chametz). Also, chametz grains may become inadvertently mixed together with kitniyot. Therefore, to prevent confusion, all kitniyot were prohibited.

In Jewish law, there is one important distinction between chametz and kitniyot. During Passover, it is forbidden to even have chametz in one's possession (hence the custom of "selling chametz"). Whereas it is permitted to own kitniyot during Passover and even to use it - not for eating - but for things like baby powder which contains cornstarch. Similarly, someone who is sick is allowed to take medicine containing kitniyot.

What about derivatives of kitniyot - e.g. corn oil, peanut oil, etc? This is a difference of opinion. Many will use kitniyot-based oils on Passover, while others are strict and only use olive or walnut oil.

Finally, there is one product called "quinoa" (pronounced "ken-wah" or "kin-o-ah") that is permitted on Passover even for Ashkenazim. Although it resembles a grain, it is technically a grass, and was never included in the prohibition against kitniyot. It is prepared like rice and has a very high protein content. (It's excellent in "cholent" stew!) In the United States and elsewhere, mainstream kosher supervision agencies certify it "Kosher for Passover" -- look for the label.

Interestingly, the Sefardi Jewish community does not have a prohibition against kitniyot. This creates the strange situation, for example, where one family could be eating rice on Passover - when their neighbors will not. So am I going to guess here that you are Ashkenazi and your wife is Sefardi. Am I right?

Yahrtzeit of Rabbi Moses ben Nachman (1194-1270), known as Nachmanides, and by the acronym of his name, Ramban. Born in Spain, he was a physician by trade, but was best-known for authoring brilliant commentaries on the Bible, Talmud, and philosophy. In 1263, King James of Spain authorized a disputation (religious debate) between Nachmanides and a Jewish convert to Christianity, Pablo Christiani. Nachmanides reluctantly agreed to take part, only after being assured by the king that he would have full freedom of expression. Nachmanides won the debate, which earned the king's respect and a prize of 300 gold coins. But this incensed the Church: Nachmanides was charged with blasphemy and he was forced to flee Spain. So at age 72, Nachmanides moved to Jerusalem. He was struck by the desolation in the Holy City -- there were so few Jews that he could not even find a minyan to pray. Nachmanides immediately set about rebuilding the Jewish community. The Ramban Synagogue stands today in Jerusalem's Old City, a living testimony to his efforts.

It's easy to be intimidated by mean people. See through their mask. Underneath is an insecure and unhappy person. They are alienated from others because they are alienated from themselves.

Have compassion for them. Not pity, not condemning, not fear, but compassion. Feel for their suffering. Identify with their core humanity. You might be able to influence them for the good. You might not. Either way your compassion frees you from their destructiveness. And if you would like to help them change, compassion gives you a chance to succeed.

It is the nature of a person to be influenced by his fellows and comrades (Rambam, Hil. De'os 6:1).

We can never escape the influence of our environment. Our life-style impacts upon us and, as if by osmosis, penetrates our skin and becomes part of us.

Our environment today is thoroughly computerized. Computer intelligence is no longer a science-fiction fantasy, but an everyday occurrence. Some computers can even carry out complete interviews. The computer asks questions, receives answers, interprets these answers, and uses its newly acquired information to ask new questions.

Still, while computers may be able to think, they cannot feel. The uniqueness of human beings is therefore no longer in their intellect, but in their emotions.

We must be extremely careful not to allow ourselves to become human computers that are devoid of feelings. Our culture is in danger of losing this essential aspect of humanity, remaining only with intellect. Because we communicate so much with unfeeling computers, we are in danger of becoming disconnected from our own feelings and oblivious to the feelings of others.

As we check in at our jobs, and the computer on our desk greets us with, "Good morning, Mr. Smith. Today is Wednesday, and here is the agenda for today," let us remember that this machine may indeed be brilliant, but it cannot laugh or cry. It cannot be happy if we succeed, or sad if we fail.

Today I shall...

try to remain a human being in every way - by keeping in touch with my own feelings and being sensitive to the feelings of others.

With stories and insights,
Rabbi Twerski's new book Twerski on Machzor makes Rosh Hashanah prayers more meaningful. Click here to order...